When Bipolar Medication Doesn’t Work: Disappointing Your Dr.

I am a very difficult case of bipolar to treat. Believe me. I have been on more bipolar medications than anyone I know and finding an effective cocktail is akin to walking on water. It’s possible, but it’s pretty darn rare. And recently I made a medication change from one antipsychotic to another. It went very badly in a whole host of ways. In fact, I terminated the medication trial early and went back to my previous medication.

I see my doctor this afternoon and now I have to tell him the bad news about how it went. And I feel guilty about failing another bipolar medication. I know he will be disappointed and I feel bad about it.

Failing Treatments

Yes, some people will correct me and say, “The medication failed you.” Well, use all the wordplay you want, it still feels like I failed another medication treatment.

Disappointing Doctors

And, if you have a decent doctor, the doctor is disappointed when treatments fail. They’re not disappointed in you, of course. They are disappointed in the failure. But it’s easy to feel like this is a disappointment in you. It’s easy to read this like you’ve done something wrong. It’s easy to feel like it’s your fault.

And it’s hard to see the look of disappointment on your doctor’s face – especially if you like him. And this look gets more and more pronounced the more treatments that fail.

It’s Not Your Fault

But, as I said, it isn’t your fault. I admit that it feels like it is but we need to remember that this is a depression thing. Depression looks to make us feel bad about everything regardless as to whether there is any actual blame to be had. And in this situation there is no blame. Your chemistry just didn’t match with the chemistry of a drug. That’s no one’s fault.

Scientists see a negative result as favourably as a positive one. This is because a negative result is still a result. It’s still data to take into account. It’s still one step closer to the answer you seek. So we can view medication trials in the same way. If a medication doesn’t work then it’s just one more data point. It’s just one more medication to cross off the list. Yes, because we have personal skin in the game, we would have preferred that it work, but if nothing else, we still got a data point out of it and that data point can help get us to the answer we seek.

Because something will work. It takes time, patience, persistence and a good doctor, but it will happen. If nothing else, this I have learned. Eventually neither of you will be disappointed. But it can be an agonizing wait getting there – and that time will be hard enough so try not to spend it beating yourself up too.

We could be medication sisters, Natasha. Sometimes it’s not only disappointing and frustrating the psychiatrist. With a violent, life-threatening allergic reaction to Saphris this week, which is new and hadn’t crossed my radar, didn’t connect the dots that it was the introduction of the new drug that made me so sick, not the head cold going around the house. When I begged the doctor to put me back on Geodon, she refused and wants to try Zyprexa since my antipsychotic seemed to plateau as I was rapid cycling way too much. I am PETRIFIED to try another antipsychotic. Psychiatric “cocktails” are admittedly hard to tweak, and it takes time, but if we know one thing about bipolar disorder, it’s that there is no cure and no magic bullet, which is rough.

Lets say the large pharmaceutical companies met and came to the conclusion that only one of two generation anti-psychotics worked. The battle is still raging, and in some circles dosage seems to make a significant difference. Personally I have found that dosage, auxiliary drugs, and the time of day medication is taken works for me. Two many variables to juggle? I spent a year in Atlanta looking for the right doc. the right med. and the right phd. Conclusion – a new socio-economic environment changed me more for the better than words of wisdom and industrial excrement of the Rx kind. Conclusion: “Know thyself.”

So sorry for those who struggle with finding workable meds. Lucky for me I am not having that problem. I just have a hard time GETTING what I need without INSURANCE. Psychiatrists Aren’t exactly County Clinics’ Specialty.

I went through a couple of years of depression then mania before we got the meds right. In the meantime I was diagnosed with Schitzoaffective disorder which is a combination of bipolar and schitophrenia. My last hospital stay was where I was put on the “right meds”. Even though I still get depressed at times for the most part my head is clear and I have control of my mind well most of the time. I guess this is the closest thing to sanity that I ever got to. I complain a lot sometimes but that passes also. It is worth the wait for the right coctail to be made just for you.

I’ve been struggling with this for years. I do consider it a personal failure. I guess because when I say years I mean over 2 decades. Part of the problem is I have an ok head doc but there are no good pill docs in my area. Add in the health insurance problem & my weak will, I never see to gain traction. I took myself off everything a week ago because I swear the newest cocktail just made me dwell on ‘not wanting to be here’ (not active suicide, just apathy) all the time. I don’t know what to do anymore.

Hello, I myself was diagnosed with bi-polar II back in 2010 when I was definetly going through all the signs of mania like staying up for days and days, talking very fast and rambling, shopping and getting myself in severe debt,etc…but then I broke my left femur in a freak slip and fall and was bed-ridden for 6 months unable to even wash myself,etc. I fell into such a depression and mind you back when I was only 12 years old was the first of many mant suicide attempts that stopped in my 20′s when I met my husband and had a child. I just couldn’t consider that an option as far as doing that to them although even today right now as I am typing this I can’t help but pray that one day I will just not wake up. Aside from my mental illness I also suffer from chronic migraines, fibromyalgia, insomnia, and heart issues. I knew from birth I had a heart murmur and always had a rapid heart rate anywhere from 110-140 all the time. Finally saw a cardiologist and after an echo-cardiogram and a 24 hour holitar monitor found out I have high blood pressure, an enlarged and over-worked heart, and three leaky valves. So again in the depths of my sick mind I was almost happy about this news. Which brings me back to this diagnosis of bi-polar II, in the years since my leg broke I seem to be depressed or anxious all the time and yet every in-patient psych stay, I had three seperate stays in 2012 alone, I have been given Lithium,Depakote,and now I’m currently on 300mg a day of Lamictal for the past 7 months or so and have had NO improvement. For my anxiety I take 2mg of Klonopin twice daily and then 2mg of Ativan as a PRN when I’m having a panic attack and I take about 2 of those a day on top of the Klonopin, for the insomnia I take 3mg of Lunesta and was put on Saphris 5mg at night but had too many side effects I stopped taking it. Lastly I was on Wellbutrin for a few months I don’t even remember the mg because it did absolutely nothing for me and so I keep asking my psychiatrist to get me on something strong and works quickly for this depression cause I can not get out of this funk and my family is paying for it severly. My husband doesn’t believe in mental illness, he sees it as a weakness and excuse for not doing anything and he resents the fact he is pretty much a single parent most of the time. He is only staying with me at this point because I need his health insurance since I’ve been on disability for the last 10 years or so for the migraines, and deep down I know he must still care for me or at least due to me being the mother of his child…but its scary to think about being better and then losing him. As far as my 10 year daughter goes she is old enough now to know that when Mommy isn’t well its not just a migraine that its something in her mind…I mean she has known why I was hospitalized last year, she sees the bottles and bottles of medication I must take, and worst of all when I have had severe side effects from some meds. that the ambulance was called to the house she is actually afraid to be alone with me and I can’t blame her. I just wonder if this diagnosis could be wrong since these days it seems like evryone is bi-polar and if it is wrong maybe the right diagnosis followed by the right medication can help my life become an actual life…at the end of my rope…Malissa

Obviously, I can’t diagnose you but what I can tell you is that the presence of mania and the presence of depression in the same person indicates bipolar disorder. Is it possible that it could be something else? It doesn’t sound like it if you primary symptoms are mood-related.

As for bipolar depression, only three medications have been approved for it and it doesn’t sound like you’ve been on any of them.

If you haven’t tried those, then you absolutely should talk to your doctor about them.

Also, in really intractable cases ECT is an option, but you probably want to try those drugs first. (ECT works quickly when it does work though, and that’s its advantage (plus it’s highly effective for most). It’s disadvantage is some memory loss.)

I know how hard it can be as well, I have been on every kind of medicine and none have worked. Because none have worked I can’t find a doctor to keep trying to get me better. I’m scared what my future holds. My moods are getting worse, not able to sleep for days on end, not able to eat, having more and more panic attacks. And to be honest the thoughts are getting sadder is a way to put it. Is there anyone out there that has any ideas on what I can do. I’ve been looking up on line for options for treatment without medicine and i’m not getting any where and I really need help. PLEASE HELP IF YOU CAN.

Angel’s situation is unacceptable. I wonder if she has few choices due to insurance?

I’m out of treatment options, but my psychiatrist sees me anyway since I do have serious depression problems and want a psychiatrist who knows me so I could get lithium if I needed it. It bothers me that Angel can’t get a doctor. Heck, my husband has no more treatment options for his eyes (macular edema) either, but the retina doc still wants to monitor him. Seems negligent, if Angel has serious problems, doesn’t it?

I will repeat here – in my case, the treatments greatly worsened my mood problems, and gave me a bunch of behavioral and cognitive problems. So now I’m off the meds, and 4 years later, back to the original bipolar (it took a LONG time) and I wish I’d given up treatment sooner, because at least I can think and I’m a pleasant person again. But if a person is going to go off the prescribed drugs, they should still have a doctor.

A lot of bipolar doctors (probably most, maybe all) think bipolar is many different disorders, and maybe that’s why some people get good results, and others have a long running disaster with the drugs.

Angel, Good quality sleep is imperative for good mental health — there is melatonin which you can try (over the counter — talk to your doctor of course for his/her suggested milligram and ok to take it). Have a relationship with your pharmacist ask him or her what time of the day to take your medications, I was practically a zombie being on medications in the am and pm and then I asked my psychiatrist if Ii could take my meds at night — then I could sleep soundly and was able to function better in the day (I was unable to drive I was so sleepy). There are also meds for sleep but for me most of these meds had the opposite effect on me and made me manic. I found trazadone helpful for quite sometime, You say you gave not seen a doctor in six years there are new meds now, perhaps try to see one. Also meditation, drinking water, practicing gratitude, also if you are interested in something simple you can do for your self try EFT or tapping therapy. Try also local peer support drop in places you can find these in most counties. You are not alone. I am also a fan of Sleepytime Tea before bed (Celestial Seasonings). I have bi-polar and have had seven major hospitalizations for mania and have gotten better despite the odds.

Provigil, Modafinil are the future Medications that WILL work for Bipolar/Major Depressive Disorder and the real bonus is its intial use was/is for SWSD and Narcolepsy and we all know , WE’RE TIRED., Depression, Medications, Iratic sleep patterns , and I believe most of all were tired from a constant on going Battle with our disorders and general health problems that accompanies them , OK Im sick and tired of fighting jusr to maintain being Sick and Tired , after 11 yrs , well looking back really it been 42 yrs , however the last 11 IDK I did really well by being prepared and always a head the game , I used. My add and insomnia to grow and prosper , Im working with a Therapist from heaven other than my therapist I have very little support and the meds help I guess but Ive decided at this point in time I have one goal and that’s to focus on Quality Of Life instead of wasting it on dead lock , Please don’t misunderstand I am not giving up , Id simply rather lose the battle to win the war , Someday these meds will be more readily available possibly for me with 6 months and other meds. Like Ketamine have worked wonders for those who DR, suggest or in some cases prescribe OH YA the Good Providers keep up with the latest treatments and they know all about these meds and more its not their fault ,its the drug co and Gov ., I know the inherent

Provigil, Modafinil are the future Medications that WILL work for Bipolar/Major Depressive Disorder and the real bonus is its intial use was/is for SWSD and Narcolepsy and we all know , WE’RE TIRED., Depression, Medications, Iratic sleep patterns , and I believe most of all were tired from a constant on going Battle with our disorders and general health problems that accompanies them , OK Im sick and tired of fighting jusr to maintain being Sick and Tired , after 11 yrs , well looking back really it been 42 yrs , however the last 11 IDK I did really well by being prepared and always a head the game , I used. My add and insomnia to grow and prosper , Im working with a Therapist from heaven other than my therapist I have very little support and the meds help I guess but Ive decided at this point in time I have one goal and that’s to focus on Quality Of Life instead of wasting it on dead lock , Please don’t misunderstand I am not giving up , Id simply rather lose the battle to win the war , Someday these meds will be more readily available possibly for me with 6 months and other meds. Like Ketamine have worked wonders for those who DR, suggest or in some cases prescribe OH YA the Good Providers keep up with the latest treatments and they know all about these meds and more its not their fault ,its the drug co and Gov ., I know the inherent risks with medication I also know whether its the meds our mental health or both WE live shorter lives and seem yo be prone to other illnesses like dementia , Im going live the best life I can while I. Stillcan , hopefully new meds and continued therapy will at some point in the future change some of these thinka for the better , but the reality is theres no guarantee with new treatments and i need base the future on what treatments have been and are available . I accept the end game I see play out for everyday in the generation ahead of me and Im the next generation thats So I wish you all luck and My only advice RESEARCH RESEACH AND STAY UP TO DATE WITH new information and treatments we cant expect our providers to be able to handle the demands of US lol and keep a constant watch on all these meds , treatments and new information on alll the different things the treat their patients for , God Bless and Good Night

My doctor was kind of a jerk. Even when the Lithium made me worse, he continued to deny that I try another medication saying I was not “med compliant” and discontinued treatment. I’ve been off medications for 8 months but I still have symptoms of Bipolar. I guess the drugs didn’t work for me.

I’m sorry your doctor was a jerk. That sounds unprofessional, too. Some doctors are like that, I’m afraid.

I just wanted to say that just because lithium didn’t work for you doesn’t mean that drugs don’t work. There are many drugs FDA approved to treat bipolar disorder and many beyond that that are used off label. Additionally, a cocktail is often what’s needed in bipolar disorder.

I loved your blog post. I suffer with the same problem trying to find a cocktail of medicines that will work for me. I feel lost a lot of the time and that makes my depression and self-esteem even worse. It is like a game of Russian roulettes it going to work this time?

I am diagnosed with bipolar and have had it for @ 20 years I’ve been in 3 ” treatment centers ” and have been through a behavior modification / drug rehabilitation program for 18months I’ve been on Depakote,lithium, thorizene, resperidol , resperidone , Paxil, Zyprexa, others I can’t remember, and even some seizure meds, pretty much every ting out there and it either didn’t work or made me worse , I go to counseling but got tired of being the lab rat I have been depressed for the past 3 years and now I am coming out of that finally and in my manic stage which is dangerous don’t know what to do I have blackout rages and have incredible strength and don’t remember what I said or did it scares me cut I can hurt someone or worse !!!!! Any suggestions it’s been like this since I was 16 and the racing thoughts lack of concentration is getting old I’m tired of this it’s ruining my life ……i been self medicating with Xanax and Adderall I know I’m not supposed to and I don’t mix em I take what I need for the moment to get me moving or to keep me from hurting someone when I feel I’m going to flip my top over the years I can feel it coming most times so I try to get away from everyone

Medication therapy in psychiatry is the first and crucial intervention on current treatment of mental illnesses. So is the same for bipolar medication, which one exhibits perplex psychosocial and biochemical issues. Personal and life circumstances, on the other hand, overloaded the comprehensive and satisfying medication of bipolar mood disorder. Indeed the algorythm of bipolar medication is complex and should be in close supervision of experienced and steady clinical psychiatrist. The efficacy of medication in this chronic and variable psychiatric entity depends on readiness of the patient to accept and implement the intrigued set of psycho-pharmacologic recommendations. Therapeutic alliance indicates important knocker on instant and smart medication of any patient with bipolar disorder. After these challenges on medication of bipolar mood disorder, we can say that individual genuine experience is the best approaching, in order to overcome and solve strange and side effect of medication. To achieve the standard of therapeutic alliance, it ought to create and maintain positive, bountiful and goodness relationship. These complicate interpersonal corporation require , beside above mention prerequisites, emotional investment from psychiatrist, which is called empathy. This kind of psychiatric provide didn’t look out but it feeling by patient. Without this personal features of psychiatrist, others undertakings and engagements will be of temporary and unsatisfying character.

I’ve taken every single psych med to date. Almost all of them 2-4 times. I’ve been bipolar since a child. I’ve taken meds for 25 years. I’ve always been treatment resistant, it runs in my family just like mental illness. It’s a neccessity to stay positive. I did everything every single doc told me to without fail. Even when I knew it was going to go bad and it did more often than not. I’ve spent over half my life fighting my illness and adverse reactions, severe side effects, doc prescribed overdoses, meds that did absolutely nothing, overcoming severe reactions that made me psychotic, schizophrenic, horrifyingly manic, hospitalizations and failing my doctors consistently. I think it’s time for someone to let others know a truth about psych meds. There is the chance you will never find one. I, personally have reached that point finally. It’s not my fault. My doc is disappointed. However, I’ve reached the end of the road. Talk about feeling like you’ve disappointed your doc! I read these articles about taking meds and trying new combos and how to keep at it. You should also know the day may come when their are no more meds. No one every even suggests that possibility. Half my life that has been one of my nightmares. It’s come true. I’m not saying give up on meds. Not at all. I do wish someone would have mentioned the chance I would disappoint my doc, period! It would’ve made my current disappointment a lot easier and less scary. I do not mean to discourage anyone. I’m an extremely rare case. I just think it’s time someone was brutally honest about psych meds not working. It would’ve helped me. Now that I’ve no med to do anything to me I’ve decided to try Accupunture. Never stop fighting but always be prepared for psych meds to disappoint you and don’t believe everything a doc tells you about meds. I believe that is what this article should actually say. Instead of cheering you up about you disappointing a doctor. Best wishes to you all!